Shoulder Replacement Overview
Shoulder joints can become significantly stiff and painful from arthritis, and in some cases can be helped by a replacement procedure. In most cases the shoulder tendons need to be intact for a standard shoulder replacement to be successful. The surgery is done under a general anaesthetic through a 3 to 4 inch incision at the front of the shoulder. One or both sides of the joint are replaced. Patients usually go home within a day or two of the operation. A sling is worn for about 3 weeks, and rehabilitation with exercises and physiotherapy is needed for several months. Relief from arthritic pain is significant, with varying degrees of restoration of strength and range of motion.
Shoulder Replacement Details
Shoulder joint replacement is generally reserved for cases where the joint surface cartilage is completely worn away. This will result in significant and fairly constant pain, loss of motion, and reduction in arm function. A standard shoulder replacement can be performed if the rotator cuff tendons are still mostly intact. There are several types of shoulder replacements, and the one we typically use is a resurfacing procedure.
The surgery is performed under a general anaesthetic, and sometimes an additional nerve block is performed for post-operative pain control. A 3 or 4 inch inch incision at the front of the shoulder allows access to the shoulder joint. The worn and irregular surface of the head of the humerus, or upper arm bone, is reamed back to a hemisphere, and a round metallic cap is fitted to resurface it. This retains more of the patient’s own bone and normal anatomy than procedures that require the head of the humerus to be cut off and a stem placed down the shaft of the humerus.
Patients are kept in hospital for a day or two, for pain control and initiation of physiotherapy. A sling is worn for the first 3 weeks. Physiotherapy and exercises are required for several months to restore range of motion, strength and function. Driving can commence after 4 to 6 weeks, overhead activities may take several months to achieve, and there can be ongoing improvements up to a year after surgery.
Possible complications to be aware of are anaesthetic problems, infection, blood vessel or nerve damage, and tendon injury. While relief from arthritic pain is usually excellent, there can occasionally be persistent symptoms. It is difficult to predict how much range of motion will be regained, and the stiffer the shoulder has been before surgery, the greater the chance that there may be some persistent stiffness. Smoking, obesity, and diabetes can adversely affect outcomes. Very rarely a shoulder replacement will need to be revised.
There are other types of shoulder replacement that may be indicated in certain situations. For some cases of shoulder arthritis, including inflammatory arthritis, the socket or glenoid needs to be replaced as well. If there is a rotator cuff tear which is large and irreparable, with significant shoulder weakness, a reverse replacement or arthroplasty can be an option, where the ball and socket are interchanged. For severe collapse of the humeral head or in fracture cases, a longer stemmed implant may need to be used. These options may be suggested by Dr. Klippenstein.